Jim Clark: The demise of Obamacare is almost upon us (opinion)
The City of San Francisco, arguably the most liberal enclave in America, has finally learned a hard lesson … government controlled enterprises do not work well.
After seventy-six years, according to the San Francisco Chronicle, “Baghdad-by-the-Bay” has finally turned its public housing operation over to private developers. Under city housing authority management, tenant complaints included cockroach infestations, broken elevators, uncollected garbage and lack of heat.
It does not appear that President-elect Trump and his GOP Congress are going to allow seventy-six years to pass before they take a scalpel to another government controlled enterprise called Obamacare (or more correctly, the “Patient Protection and Affordable Care Act”).
When government dictates health policy terms (such as mandatory free birth control for aging nuns) and mandates its citizens to obtain policies or face a fine or prison, you know the enterprise won’t run on its own.
Trump and other Republicans campaigned on repealing and replacing Obamacare. Their opponents responded: “replace it with what?” They might have looked at H.R. 2300 sponsored by Congressman Tom Price (R-GA) and S. 1851 sponsored by Senator John McCain (R-AZ).
The identical bills are commonly referred to as the Empowering Patients First Act (“EPFA”). The measure would repeal Obamacare and replace it with a market-driven health care plan. It is still in draft form because Obama threatened a veto if it ever becomes law. After the 20th of next month, that threat evaporates.
Since Price, an orthopedic surgeon, is President-elect Trump’s nominee for Secretary of Health and Human Services, the measure is likely to become the law of the land. Adios Obamacare!
EPFA would replace Obamacare and take health care in a fundamentally different direction, away from mandated coverage and toward a free market approach. There would be fewer consumer protection regulations and more freedom for physicians. It is intended to lower the cost of health insurance and keep growth of government in check.
The measure would eliminate the present penalty or tax on individuals who fail to obtain health insurance and substitute an age-based tax credit to provide the means of paying for health insurance.
It would offer other tax credits as incentives for individuals to contribute to health savings accounts. The measure would provide for federal grants to states to help pay for “high risk” populations. It would allow insurance companies to compete across state lines and finally would make it more difficult to sue doctors for malpractice if they follow certain “clinical guidelines.”
The measure would restrict Obamacare’s “preexisting conditions” mandate (requiring insurers to issue policies to known health risks at no increase in cost) to individuals who have maintained coverage in the past.
Obamacare’s funding for states that expand Medicaid would be jettisoned. States can use federal grant money to help those with preexisting conditions who don’t qualify and/or to subsidize low income people who can’t afford market rate policies.
Note the switch in emphasis from big government solutions to individual responsibility and decentralization. Where Obamacare subsidies vary with income, EPFA tax credits (same thing, basically) are based on age, since health care needs increase as we grow older. Rather than continuing to subsidize states for expanding Medicaid, EPFA grants to states would impose no such restrictions so they could use the money as they see fit.
The financial impact of the Empowerment Bill has not been assessed by the Congressional Budget Office, but former CBO Director Douglas Holtz-Eakin estimates that the measure would save $2.3 trillion over 10 years and increase the number of insured individuals by 29% by lowering premiums.
Could be, but critics think the restriction on mandating insurance for those with pre-existing conditions is the measure’s Achilles’ heel. President-elect Trump favors retention of that mandate, so we shall see.
In any case, there are still enough Democrats in Congress to guarantee a big fight.
Jim Clark is president of Republican Advocates. He has served on the Washoe County and Nevada GOP Central Committees. He can be reached at firstname.lastname@example.org.